台灣地區自民國八十四年三月開始實行全民健保，並於同年七月起提供三十歲以上婦女每年一次免費抹片檢查，但我國婦女抹片檢查利用率和先進國家相比仍舊偏低。爰此，本論文主要目的，在探討台灣地區婦女在健保制度下抹片篩檢利用度的影響因素，藉由實證分析結果，期能提供政府當局有效提高篩檢率的具體方針和建議，以有效降低婦女子宮頸癌的發生率和死亡率。 第二章為理論架構，分別應用Becker(1965)的家庭生產函數和Grossman(1972)的健康需求模型，以建構影響抹片檢查需求的理論模型，並為本論文實證分析的理論基礎。本論文實證分析共分三章，首先利用衛生署國民健康局家庭計畫研究所，分別於民國81年及87年進行的「台灣地區家庭與生育力調查」資料，採用Logit迴歸模型做分析。實證結果發現，抹片檢查接受與否的影響因素在健保實施前後有很大差異，而「南部＊全民健保」及「鄉鎮＊全民健保」的變數對30歲以上婦女亦為顯著正相關；意味健保制度的推行，沖消掉大多數變數的影響效果，使得原本具有影響力的因素變為不顯著，亦即健保政策在婦女抹片防癌使用度的增加有很大貢獻。此外，政府除了對30歲以上女性提供免費檢查給付政策外，亦積極加強衛教宣導工作、建立子宮頸抹片篩檢服務網等工作，使得「全民健保」變數不僅對30歲以上婦女，亦對30歲以下婦女有顯著的正影響力，故建議政府可考慮將篩檢給付擴及至所有已婚女性。 接者，在第四章則利用國家衛生研究院於民國90年所進行的「國民健康訪問調查」資料，應用Bivariate Probit 迴歸模型，並將台灣地區所有316個鄉鎮市分成八個都市化層級，探討都市化程度高低對婦女預防保健利用度之影響。結果發現都市化程度不同，的確造成婦女抹片檢查利用率存在顯著差異，居住在第二至第六個都市化層級的婦女，其接受抹片篩檢的比率明顯較都市化程度最高者低；而第七和第八層級(都市化程度最低)並無顯著較第一層級不願做篩檢。究其原因，乃因政府為均衡不同地區抹片篩檢的可近性，積極鼓勵相關醫療院所加入健保特約醫院，以配合健保給付政策並提供篩檢服務，至民國86年，有超過90%約1500家的醫療院所加入；此外，衛生當局亦在偏遠地區提供巡迴車設站採檢服務，以解決偏遠地區醫療資源不足問題。意味全民健保制度在婦女抹片檢查服務上，已達到提昇偏遠地區醫療服務可近性的貢獻。 最後，在第五章我們利用國民健康局於民國91年所進行的「國民健康促進知識、態度與行為調查」資料，應用兩階段最小平方法(2SLS)估計模型，分析健康資訊對抹片檢查的影響程度。應用Kenkel(1990)衡量資訊的方法，將受訪者對子宮頸癌及抹片檢查相關知識的得分加總，以代表婦女健康資訊程度。實證結果發現，健康資訊的確是影響婦女是否接受抹片檢查的重要因素，擁有愈多相關健康資訊的婦女，因愈了解抹片檢查對預防子宮頸癌的重要，故明顯較願意去接受篩檢。因此，政府除了積極全面衛教宣導工作、建立子宮頸抹片篩檢服務網等工作外，也應針對擁有較低健康資訊的婦女多加宣導抹片防癌的重要性，以有效提高我國婦女的篩檢利用率。 / The National Health Insurance program provided free annual cervical cancer screening for women aged above 30 years old since July, 1995, just four months after the inauguration of the NHI. Therefore, the purpose of this dissertation is to investigate the demand for Pap-smear utilization among women under NHI program. To explore the factors influencing cervical cancer screening and the empirical results can be of great importance to health policy decisions aimed at reducing the incidence and mortality of cervical cancer. In Chapter 2, we attempt to analyze the theoretical foundations applying the household production function developed by Becker (1965) and Grossman’s (1972) health decision-making model and summarize the literatures through a review of the demand for preventive care services. Three empirical essays will proceed in following three chapters. First of all, chapter 3 presents data obtained from the 1992 and 1998 surveys on ‘Knowledge, Attitudes and Practice’ administered by Taiwan’s Provincial Institute of Family, performing a logit model. The results show that factors affecting Pap smear test utilization varied significantly before and after NHI, besides, the coefficient of the South＊NHI and village/town＊NHI interaction variable for women above 30 become significant and positive. This indicates that NHI system plays an important contributor on reducing the disparities in utilization of Pap smear tests between different areas. In addition to NHI coverage, other strategies such as strengthening educational activities and establishing a service network for Pap-smear screening are other vital contributors to increase the utilization rate of Pap smear screening for those aged below 30 years under NHI. To further increase the utilization of cervical cancer screening, the insurance coverage could be extended to all married women regardless of age. In chapter 4, we attempt to explore the impact of urbanization level on the use of female preventive services under NHI, using a bivariate probit model and dataset obtained from the 2001 National Health Interview Survey provided by the National Health Research Institutes. All 316 cities/counties in Taiwan was stratified into 8 levels of urbanization. The results showed that urbanization levels have a significant influence on Pap-smear screening. Those living between the second and sixth levels of urbanized regions were significant negative to the cervical cancer screening compared to the highest urbanization level. In order to balance the accessibility of cervical cancer screening between different areas, the health authorities encourage the obstetric, gynecological hospitals and clinics to contract with the government, more than 90%, about 1,500 medical care institutions were under contract until 1997. Besides, government authorities introduced mobile testing stations to provide specimen collection services in the deeper remote regions. As a result, those living in the areas with the 7th level and the 8th level (the lowest level) of urbanization were not less likely to take Pap-smear test. It means that the implementation of NHI has enhanced the accessibility of taking pap-smear test. Finally, in chapter 5, the nationwide survey dataset was obtained from the 2002 Health Promotion of Knowledge, Attitudes and Practice (HPKAP) in Taiwan, provided by the Bureau of Health Promotion and two-stage estimation model was adopted to investigate the association of cervical cancer screenings with the healthcare information. The results showed that women’s healthcare information has a significant positive effect on the utilization of cervical cancer screening; that is, the more informed women are, in terms of information and knowledge on cervical cancer screening, the more likely they are to undergo Pap-smear testing. Therefore, it is important for the healthcare authorities to place greater effort into strengthening the knowledge and information on cervical cancer screening and Pap-smear testing, for those who are currently less informed, so as to enhance the overall efficiency of the screening program.

No description available.

Made available in DSpace on 2014-12-17T15:06:58Z (GMT). No. of bitstreams: 1 RodrigoNQ_DISSERT.pdf: 3682649 bytes, checksum: 33832ac05cfe929df2ad407d3f5c4739 (MD5) Previous issue date: 2012-11-30 / Research in the area of teacher training in English as a Foreign Language (CELANI, 2003, 2004, 2010; PAIVA, 2000, 2003, 2005; VIEIRA-ABRAH?O, 2010) articulates the complexity of beginning teachers classroom contexts aligned with teaching language as a social and professional practice of the teacher in training. To better understand this relationship, the present study is based on a corpus of transcribed interviews and questionnaires applied to 28 undergraduate students majoring in Letters/English emphasis, at a public university located in the interior of the Western Amazon region, soliciting their opinions about the reforms made in the curriculum of this Major. Interviews and questionnaires were used as data collection instruments to trace a profile of the students organized in Group 1, with freshmen and sophomore undergraduates who are following the 2009 curriculum, and Group 2, with junior and senior undergraduates who are following the 2006 curriculum. The objectives are to identify, to characterize and to analyze the types of pronouns, roles and social actors represented in the opinions of these students in relation to their teacher training curriculum. The theoretical support focuses on the challenge of historical and contemporary routes from English teachers initial education programs (MAGALH?ES; LIBERALLI, 2009; PAVAN; SILVA, 2010; ALVAREZ, 2010; VIANA, 2011; PAVAN, 2012). Our theoretical perspective is based on the Systemic Functional Grammar of Halliday (1994), Halliday and Hasan (1989), Halliday and Matthiessen (2004), Eggins (1994; 2004) and Thompson (2004). We focus on the concept of the Interpersonal meaning, specifically regarding the roles articulated in the studies by Delu (1991), Thompson and Thetela (1995), and in the Portuguese language such as Ramos (1997), Silva (2006) and Cabral (2009). Moreover, we ascribe van Leeuwen s (1997; 2003) theory of Representation of Social Actors as a theoretical framework in order to identify the sociological aspect of social actors represented in the students discourse. Within this scenario, the analysis unfolds on three levels: grammatical (pronouns), semantic (roles), and discursive (social actors). For the analysis of interpersonal realizations present in the students opinions, we use the computational program WordSmith Tools (SCOTT, 2010) and its applications Wordlist and Concord to quantify the occurrences of the pronouns I, You and They, which characterize the roles and social actors of the corpus. The results show that the students assigned the following roles to themselves: (i) apprentice to express their initial process of English language learning; (ii) freshman to reveal their choice of Major in Letters/English emphasis; (iii) future teacher to relate their expectations towards a practicing professional. To assign the roles to professors in the major, the students used the metaphor of modality (I think) to indicate the relationship of teacher training, while they are in the role of a student and as a future teacher. From these evidences the representation of the students as social actors emerges in roles such as: (i) active roles; (ii) passive roles and (iii) personalized roles. The social actors represented in the opinions of the students reflect the inclusion of these roles assigned to the actions expressed about their experiences and expectations derived from their teacher training classroom / Pesquisas na ?rea de forma??o de professores de ingl?s como l?ngua estrangeira (CELANI, 2003, 2004, 2010; PAIVA, 2000, 2003, 2005; VIEIRA-ABRAH?O, 2010) dimensionam a complexidade de contextos da sala de aula de forma??o inicial em aliar o ensino da l?ngua com a pr?tica social e profissional do futuro professor. Como forma de fornecer subs?dios para a compreens?o dessa rela??o, a presente pesquisa baseia-se em um corpus composto de entrevistas transcritas de 28 alunos de um Curso de Letras/Ingl?s (CLI) de uma universidade p?blica localizada no interior da Amaz?nia Ocidental e suas opini?es acerca da reformula??o do curr?culo do curso. Os instrumentos de coleta de dados utilizados foram entrevistas e question?rios para tra?ar o perfil dos alunos do CLI concentrados em Grupo 1, com os alunos do 1? e 3? per?odos do curr?culo de 2009, e o Grupo 2, com os alunos do 5? e 7? per?odos do curr?culo de 2006. Os objetivos propostos buscam identificar, caracterizar e analisar os tipos de pronomes, os pap?is e os atores sociais representados nas opini?es dos alunos em rela??o ao curr?culo de sua forma??o inicial. O aporte te?rico enfoca os desafios do percurso hist?rico e contempor?neo dos programas de forma??o inicial de professores de l?nguas (MAGALH?ES; LIBERALLI, 2009; PAVAN; SILVA, 2010; ALVAREZ, 2010; VIANA, 2011; PAVAN, 2012). Para a perspectiva te?rica e anal?tica, apoiamo-nos na Gram?tica Sist?mico-Funcional (GSF) de Halliday (1994), Halliday e Hasan (1989), Halliday e Matthiessen (2004), Eggins (1994; 2004) e Thompson (2004). Focamos no conceito da Interpessoalidade, especificamente acerca dos pap?is abordados por Delu (1991), Thompson e Thetela (1995), e trabalhos em l?ngua portuguesa como os de Ramos (1997), Silva (2006) e Cabral (2009). A Teoria da Representa??o dos Atores Sociais de van Leeuwen (1997; 2003) contempla a base te?rica para identificarmos o car?ter sociol?gico dos atores sociais representados no discurso dos alunos. Com este panorama, o percurso proposto para an?lise percorre tr?s n?veis principais: os pronomes (n?vel gramatical), os pap?is (n?vel sem?ntico) e os atores sociais (n?vel discursivo). Para a an?lise das marcas interpessoais presentes nas opini?es dos alunos, utilizamos o programa computacional WordSmith Tools (SCOTT, 2010), e suas ferramentas Wordlist (Lista de Palavras) e Concord (Concordanciador) para quantificar as ocorr?ncias dos pronomes: Eu, Voc? e Eles, que permitam caracterizar os pap?is e os atores sociais no corpus. Os resultados demonstram que os alunos atribuem a si mesmos os seguintes pap?is: (i) aprendiz para expressar o processo inicial de seu aprendizado com o ingl?s; (ii) ingressante na licenciatura para expor suas escolhas em cursar Letras/Ingl?s; (iii) futuro professor para relacionar suas expectativas com a pr?tica profissional. Para atribuir os pap?is aos professores e o curso, os alunos utilizam a met?fora de modalidade, Eu acho que para marcar as rela??es da forma??o inicial como aluno e futuro professor. Destas evid?ncias emergem os atores sociais representados pelos alunos em: (i) pap?is ativos; (ii) pap?is passivos e (iii) pap?is personalizados. Esses atores sociais representados nas opini?es dos alunos refletem a inclus?o dos pap?is atribu?dos para as a??es expressas acerca das experi?ncias e expectativas oriundas da sala de aula de sua forma??o

Cervical cancer, a completely curable disease with early detection and management, is an international concern. Early identification allows for treatment of the disease, which prevents or slows progression, ultimately reducing morbidity and mortality. Due to the regressive nature of most cervical lesions, the duration between cervical cytology has been lengthened to prevent over diagnosis and treatment. This was reflected in the 2012 United States Preventative Services Task Force (USPSTF) clinical practice guideline for cervical cancer screening. The purpose of this project was to determine the effectiveness of a quality improvement initiative to increase adherence to the 2012 USPSTF guideline at a volunteer medical clinic for the working uninsured. In this retrospective, time series observational evaluation, data were collected via chart review regarding adherence to the guideline. The intervention consisted of the placement of a visual algorithm educational tool for clinical decision-making for cervical cytology screening in each exam room. Data were collected during three time periods: (1) the 3 months prior to initial education of clinic staff regarding the guideline; (2) the 3months between initial education and introduction of the algorithm; and (3) the 3 months post introduction of the algorithm. A total of 335 charts were reviewed. There was a significant difference in the proportion of appropriate screening among the three groups (Χ2= 6.83 p=.03). There was also a significant difference in appropriate screening rates between the new and established patients’ group, controlling for group (p<.0001). The use of the interventional algorithm is recommended to improve adherence to evidence-based practice guideline related to cervical screening as it decreases harm(s) to the patient by reduction of fear, cost to the patient, and overtreatment of benign regressive lesions.

During her theoretical training as an educational psychologist, the researcher was intrigued and fascinated by the expositions on the functioning of the self. With this study she pursued her goal to gain a clearer understanding of the formation and development of the self in a child, with the focus on the child in middle childhood (6 -12 years). In this study, she mainly focused on understanding the connection between the three crucial components of the self, self-concept and self-esteem. Her passion for art inspired her to be inventive and apply artistic creative methods of drawing, painting and clay human modelling as projective means to access the child’s unconscious mind, revealing pivotal experiences and emotions, revealing how the child relates to his or her self. According to this qualitative arts-based research study, the DAP (Draw a Person) and variations of PAP (Paint a Person) and CAP (Create a Person) with the use of appropriate DAP, PAP and CAP questionnaires, seem relevant therapeutic projective measures to assist in educational psychology in exploring the child’s self. / Further Teacher Education / M. Ed. (Guidance and Counselling)

MPH / Department of Public Health / See the attached abstract below

This study examines the accessibility and barriers that Polish immigrants face in public gynecological care in Sweden and explains their attitudes towards and frequency of gynecological visits. To understand attitudes of the research group, the study explores their knowledge about basic gynecological health topics such as Pap and HPV tests, HPV infections and vaccinations. Qualitative ethnographic methods were used in this research. Thirteen semi-structured interviews were conducted with 25 to 45-year old Polish women living in Stockholm, Sweden. Analysis was performed using descriptive and theoretical approaches. The results indicate several barriers to fully adapt to the Swedish healthcare system for Polish women. The barriers included the lack of understanding of how Swedish gynecological care works (division of specializations), problems in finding specialist care, an insufficient number of specialists, a lack of information in English or Polish, and a limited amount of knowledge among study participants about HPV tests and vaccinations. The adaptation of Polish immigrants to the Swedish system and their level of trust is influenced by their first experiences in Sweden, health literacy, experiences with the Polish private gynecological system, and the attitudes of partners and family with Swedish backgrounds or those who have long term experiences in Sweden.

No description available.

Les contre-exemples de Frankfurt sont inoffensifs contre l’argument de la conséquence (consequence argument), l’argument qui, à partir du principe des possibilités alternatives et du déterminisme, montre que nous ne pouvons être tenus moralement responsables de nos actions. En effet, ils sont formulés soit dans un cadre déterministe, soit dans un cadre indéterministe. S’ils sont formulés dans un cadre indéterministe, ils sont inoffensifs parce qu’ils contreviennent à un principe méthodologique que nous défendons : le principe de non-négation des prémisses (PNNP). En fait, nous montrons que pour tout argument donné, il est proscrit de supposer la négation d’une prémisse afin de réfuter une autre prémisse à moins que l’attaque réussisse à réfuter les deux prémisses en question. Or, d’une part, les contre-exemples de Frankfurt indéterministes supposent explicitement qu’une prémisse de l’argument de la conséquence – le déterminisme est vrai – est fausse; et d’autre part, ils ne peuvent pas nous donner de raisons de croire en l’indéterminisme, ce que nous montrons grâce à des considérations sur la transmission de la justification. Construire des contre-exemples de Frankfurt indéterministes est donc incorrect pour des raisons méthodologiques et logiques. S’ils sont formulés dans un cadre déterministe, les contre-exemples de Frankfurt font face à une autre accusation d’entorse argumentative, présentée dans la défense du dilemme (Dilemma Defence) de Kane-Ginet-Widerker : celle de la pétition de principe. Nous inspectons et nuançons cette accusation, mais concluons qu’elle tient puisque les contre-exemples de Frankfurt déterministes supposent au final une analyse des agents contrefactuels dans les mondes déterministes et de la relation « rendre inévitable » que ne peuvent endosser ni les incompatibilistes de la marge de manœuvre (leeway incompatibilists), ni les incompatibilistes de la source (source incompatibilists) ni non plus les semicompatibilistes. Conséquemment, les contre-exemples de Frankfurt ne peuvent plus soutenir la forme de compatibilisme à laquelle ils ont donné naissance. L’incompatibilisme de la source ne peut plus être préféré à l’incompatibilisme de la marge de manœuvre ni non plus rejeter toute participation des possibilités alternatives dans l’explication de la responsabilité morale sur cette seule base. / Frankfurt-type examples are inoffensive against the Consequence argument, which purports to show that from both the principle of alternative possibilities and determinism, we can deduce that we are not morally responsible for our actions. Indeed, they require either a deterministic context or an indeterministic one. If they require indeterminism, they are harmless because they violate a methodological principle that we defend: the no-premise-negation principle (PNNP). In fact, we show that for each given argument, we cannot legitimately suppose the negation of a premise in order to refute another, unless the attack succeeds to refute both premises. Yet, on the one hand, indeterministic Frankfurt-type examples explicitly suppose that a premise of the Consequence argument – determinism holds – is false; and on the other hand, Frankfurt-type examples do not give us reasons to reject determinism, which we show with considerations on the transmission of justification. To build indeterministic Frankfurt scenarios is therefore incorrect for methodological and logical reasons. If they require determinism, Frankfurt-type examples are facing a different, yet very serious, argumentative accusation (presented in the Kane-Ginet-Widerker famous Dilemma defence): begging the question. We inspect and qualify this accusation. However, we ultimately claim that it still holds because a deterministic Frankfurt-type example supposes an analysis of the role of counterfactual agents and of the relation “render inevitable” in deterministic worlds that is acceptable neither for a leeway incompatibilist, a source incompatibilist or a semicompatibilist. Thus, Frankfurt-type examples no longer successfully support the form of compatibilism they contributed to give birth to. Also, source incompatibilism may not be preferred to leeway incompatibilism, nor reject all use of alternative possibilities in the explanation of moral responsibility on the sole basis of Frankfurt scenarios.

Made available in DSpace on 2011-05-04T12:36:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2009 / O desenvolvimento de vacina contra o Papilomavirus humano (HPV), que se apresenta revolucionária, pelo potencial de prevenção primária do câncer de colo uterino tem suscitado polêmica quanto à incorporação em programas de saúde pública. As evidências de eficácia da vacina se limitam a lesões invasivas pelos principais genótipos doHPV e a vacina tem custo muito mais alto do que outras vacinas do calendário vacinal do Programa Nacional de Imunização do SUS. Este trabalho analisa as possibilidades de utilização da vacina contra o HPV, considerando a efetividade do Programa de Rastreamento do Câncer de Colo Uterino do Brasil e a eficácia da vacina contra o HPV registrada. O estudo foi realizado a partir de revisão das evidências obtidas de dados empíricos, e disponíveis em relatórios, publicações e páginas eletrônicas. A vacina apresentou resultados muito favoráveis para a eficácia e segurança, porém com lacunas importantes no conhecimento sobre seu efeito a longo prazo e correlato sorológico de proteção. Os dados indicam que o programa de prevenção do câncer de colo do Brasil tem baixa efetividade, com grande heterogeneidade de cobertura e qualidade. Foi observada também uma variação muito grande com relação à acurácia do Papanicolaou, com implicações no desempenho do programa. Considerando que o controle de câncer de colo uterino continuará dependendo de rastreamento com o Papanicolaou, e que a efetividade do programa em outras partes do mundo permitiu reduzir a mortalidade, parece mais indicado concentrar esforços e recursos na melhoria do programa de rastreamento e aguardar os resultados de médio prazo da vacinação. / The development of a vaccine against human papillomavirus (HPV), which presents itself revolutionary due to its potential for primary prevention of cervical cancer, has raised controversy over the incorporation into public health programs. Evidence of effectiveness of the vaccine are limited to invasive lesions of the major genotypes of HPV and the vaccine cost is much higher than other vaccines in the immunization calendar of the National Program on Immunization of the Unified Health System (SUS). This study analyzes the potential use of the vaccine against HPV, considering the effectiveness of the Program for Cervical Cancer Control in Brazil and the efficacy of the vaccine against HPV registered. The study was carried out from reviewing the evidence obtained from empirical data, and available in reports, publications and websites. The vaccine showed very favorable safety and efficacy results, but with important gaps in knowledge about their effect in the long term and serological correlate of protection. The data indicate that the program for the prevention of cervical cancer in Brazil has low effectiveness, with great diversity of coverage and quality. There was also a very large variation with respect to the accuracy of Papanicolaou, with implications for the performance of the program. Considering that the control of cervical cancer will continue depending on the Papanicolaou screening, and that the effectiveness of the program in other parts of the world has reduced mortality, it seems more appropriate to concentrate efforts and resources in improving the tracking program and wait for the results medium-term vaccination.